EXTENSION FOR CHARITABLE ANNUAL REPORT SECRETARY OF STATE SFN 59568 (05-2018) For reference, see North Dakota Century Code Section 50-22-04. If, for any reason, the report cannot be compiled by September 1, 2018, an extension of the filing date may be granted by the Secretary of State. The extension must be requested in writing and be postmarked on or before September 1, 2018, or be faxed or emailed to the fax number or email address provided at the bottom of this form on or before September 1, 2018. The request must include the ID number that appears in the upper-right corner of the report and the extension date by which the report will be filed. Only one extension request will be granted per year. This extension applies to the report due September 1, 2018. STANDING EXTENSION: An organization with a fiscal year ending between June 1 and September 1 may request an extension to apply to reports for subsequent years until the fiscal year is changed. A standing extension must be requested in the same manner and time frame as the annual extension described above. Legal name of organization Secretary of State ID number Street and mailing address of principal office City State ZIP code Federal ID number Fiscal year end Extension date Standing extension Applicant's signature Title DateApproval for the extension should be sent to the following fax number, email address, or mailing address. Fax number Email address Address City State ZIP codePERMISSION GRANTED ONLY AFTER SIGNED AND RETURNED Office of the Secretary of State DateSecretary of State State of North Dakota 600 E Boulevard Ave Dept 108 Bismarck ND 58505-0500 Telephone: (701) 328-3665 Toll-Free: (800) 352-0867 (option 8) Fax: (701) 328-1690 Email: sosadlic@nd.gov Website: sos.nd.gov American LegalNet, Inc. www.FormsWorkFlow.com